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Brain macro- and microscopic damage in patients with paediatric MS
  1. Martina Absinta1,2,
  2. Maria A Rocca1,2,
  3. Lucia Moiola2,
  4. Angelo Ghezzi3,
  5. Nicoletta Milani4,
  6. Pierangelo Veggiotti5,
  7. Giancarlo Comi2,
  8. Massimo Filippi1,2
  1. 1Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Milan, Italy
  2. 2Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
  3. 3Multiple Sclerosis Center, Ospedale di Gallarate, Gallarate, Italy
  4. 4Child Neurology Department, Neurological Institute ‘Carlo Besta,’ Milan, Italy
  5. 5Fondazione ‘Istituto Neurologico Casimiro Mondino,’ Pavia, Italy
  1. Correspondence to Dr Massimo Filippi, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, Milan 20132, Italy; massimo.filippi{at}


Objective To characterise, using conventional and diffusion tensor (DT) MRI, the nature and distribution of lesions and the extent of damage in the brain normal-appearing white matter (NAWM) and grey matter (GM) from a relatively large population of paediatric multiple sclerosis (MS) patients.

Methods Brain conventional and DT MRI scans were acquired from 48 patients with paediatric MS (10 clinically isolated syndromes (CIS), 38 relapsing remitting (RR) MS), 30 adult CIS, 27 adult RRMS, 15 paediatric healthy controls (HC) and 18 adult HC. T2-lesion probability maps and DT MRI of lesions, NAWM and GM were compared among controls and MS groups.

Results T2-visible lesion volumes did not differ among patient groups, but T2 lesions were more frequently located in the posterior periventricular regions in adult RRMS patients than in adult CIS and paediatric RRMS patients. Adult RRMS patients had a significantly higher lesion average mean diffusivity than paediatric RRMS patients. No DT MRI changes in the NA tissues were found in paediatric and adult CIS patients. DT MRI abnormalities were limited to the NAWM in paediatric RRMS patients, while they involved the NAWM and GM in adult RRMS patients. The extent of NAWM involvement was similar between adult and paediatric RRMS patients and was significantly correlated with T2-visible lesion burden.

Conclusions A less severe intrinsic lesion damage, a less frequent lesion occurrence in the posterior periventricular WM and the sparing of GM may help to explain the favourable short-/medium-term disease outcome of paediatric MS.

  • Multiple sclerosis
  • MRI
  • paediatric
  • diffusion tensor
  • grey matter

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  • Funding This study was partially supported by a grant from Fondazione Mariani (R07-62).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics aproval Ethics approval was provided by the Hospital San Raffaele Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.